Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

Roman, Jose D

doi:10.7759/cureus.16428

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…The average hospital stay was 3.21 days (±0.82). The average hospital stay was 2.06 (±0.3) days in a study by Roman [15]. In comparison to the hospital stay for open surgery, the hospital stay was shorter that resulted in early returning to normal activities by the patient.…”

Section: Discussionmentioning

confidence: 93%

Complications of Total Laparoscopic Hysterectomy in a Tertiary Care Center

Pande¹,

Pradhan²,

Pradhan³

et al. 2023

Cureus

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IntroductionLaparoscopic hysterectomy is a standard practice in developed countries and corporate setups in India but is a relatively new practice in government institutions; surgical audits are rarely done in our institutions. This study aims to determine the complications of total laparoscopic hysterectomy (TLH) in a tertiary care center in India. MethodsThis was a retrospective record review of patients admitted to the Obstetrics and Gynecology department of Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Odisha, India. Data were collected from case sheets of patients who underwent TLH, operated on between January 2018 and May 2022. Demographic and clinical data were extracted and analyzed. ResultsOf the 223 consecutive patients, 12 (5.3%) were converted to laparotomy. The mean age of patients was 44.34 years (±5.457), with a mean BMI of 24.24 kg/m 2 (±2.181). The mean surgical duration was 1.895 hr (±0.487), with a mean blood loss of 140 ml and an average hospital stay of 3.25 (±0.821) days. Duration of surgery, blood loss, and hospital stay decreased with the surgeon's increasing experience. Reoperation was not needed in any case. Complications were recorded in about 18 (8.07%) cases. Also, major complications were less. ConclusionTotal laparoscopic hysterectomy is a less invasive and safe alternative to total abdominal hysterectomy, offering the benefits of minimally invasive surgery, and is also ideal for candidates unsuitable for vaginal hysterectomy.

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Section: Discussionmentioning

confidence: 93%

Complications of Total Laparoscopic Hysterectomy in a Tertiary Care Center

Pande¹,

Pradhan²,

Pradhan³

et al. 2023

Cureus

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show abstract

“…However, recent research indicates a conversion rate of 0.93% from TLH to laparotomy. Moreover, the incidence of intraoperative or postoperative complications is 5.7% 5 . Therefore, performing TLH remains challenging in certain situations despite it being the preferred approach 6 .…”

Section: Introductionmentioning

confidence: 99%

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study

Chen,

jiang,

et al. 2024

International Journal of Surgery

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Background: Total laparoscopic hysterectomy (TLH) is the most commonly performed gynecological surgery. However, the difficulty of the operation varies depending on the patient and surgeon. Subsequently, patient’s outcomes and surgical efficiency are affected. We aimed to develop and validate a pre-operative nomogram to predict the operative difficulty in patients undergoing TLH. Methods: This retrospective study included 663 patients with TLH from XXX Hospital and 102 patients from YYY Hospital in Chongqing, China. A multivariate logistic regression analysis was used to identify the independent predictors of operative difficulty, and a nomogram was constructed. The performance of the nomogram was validated internally and externally. Results: The uterine weight, history of pelvic surgery, presence of adenomyosis, surgeon’s years of practice, and annual hysterectomy volume were identified as significant independent predictors of operative difficulty. The nomogram demonstrated good discrimination in the training dataset (area under the receiver operating characteristic curve [AUC], 0.827 (95% confidence interval [CI], 0.783–0.872), internal validation dataset (AUC, 0.793 [95% CI, 0.714–0.872]), and external validation dataset (AUC, 0.756 [95% CI, 0.658–0.854]). The calibration curves showed good agreement between the predictions and observations for both internal and external validations. Conclusion: The developed nomogram accurately predicted the operative difficulty of TLH, facilitated pre-operative planning and patient counseling, and optimized surgical training. Further prospective multicenter clinical studies are required to optimize and validate this model.

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An attempt to omit intra-abdominal drain placement after total laparoscopic hysterectomy

Sato

Aihara

et al. 2022

JAPANESE JOURNAL OF JSGOE

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Objective: Total laparoscopic hysterectomy (TLH) has gained widespread acceptance. Although using an intraabdominal drain after laparoscopic surgery has been considered effective, there are no clear guidelines concerning it. We analyzed the cases of TLH in our hospital to see if drain placement could be omitted.Methods: From April 2020 to March 2021, 79 patients underwent TLH in our hospital. While we placed intra-abdominal drains after TLH in 33 patients (drain group), we did not place the drains after TLH in 46 patients (non-drain group).Clinical background, operation time, bleeding volume, weight of the uterus, number of days until discharge, and postoperative complications were retrospectively analyzed.Results: Three patients developed postoperative complications, of which 2 and 1 were from the drain and non-drain groups, respectively. One patient in the drain group underwent vaginal stump dehiscence whereas the other developed umbilical wound infection. Vaginal stump hematoma was observed in the patient from the non-drain group. Conclusion:This study suggested that intra-abdominal drain placement after TLH could be omitted. Further studies are warranted to support omission of drains after TLH.

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Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

Cited by 3 publications

References 15 publications

Complications of Total Laparoscopic Hysterectomy in a Tertiary Care Center

Complications of Total Laparoscopic Hysterectomy in a Tertiary Care Center

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study

An attempt to omit intra-abdominal drain placement after total laparoscopic hysterectomy

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